Provider Demographics
NPI:1043548183
Name:PETER DISTLER, MD, PLLC
Entity Type:Organization
Organization Name:PETER DISTLER, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:M
Authorized Official - Last Name:DISTLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-734-3444
Mailing Address - Street 1:P.O. BOX 1434
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-9434
Mailing Address - Country:US
Mailing Address - Phone:212-734-3444
Mailing Address - Fax:212-734-0370
Practice Address - Street 1:3 EAST 83RD STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028
Practice Address - Country:US
Practice Address - Phone:212-734-3444
Practice Address - Fax:212-734-3444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179238207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty